Diagnosis. Treatment. 303 



mains alive, a diapliragiiiatic hernia forms and later on this 

 gives rise to recurrent attacks of disease. 



Diagnosis. The most important signs for the recognition 

 of acute dilatation of the stomach are the appearance of colicky 

 symptoms after the ingestion of large masses of improper food 

 or after the horse has done work directly after feeding, severe 

 and persisting colicky pains not accompanied by any marked 

 bloating, early appearance of a weak pulse and of difficult respi- 

 ration, moderate bloating of the small intestines, belching, gag- 

 ging and vomiting and finally the result of the examination with 

 the stomach tube. Belching, gagging and vomiting or the evac- 

 uation of masses of gases and fluid through the stomach tube are 

 also observed in secondary dilatation of the stomach; on the 

 other hand, belching, gagging or vomiting may be absent in 

 primary or secondary dilatation of the stomach. It appears 

 always advisable to examine the abdominal organs by a rectal 

 exploration, because other affections, accompanied by abdominal 

 pains, and similar symptoms, may appear shortly after the in- 

 gestion of food. For differential diagnosis are particularly to be 

 considered displacements of the intestines (twisting, volvulus, 

 invagination, internal strangulation), grave forms of throm- 

 bosis and embolism and other possible causes of colicky affec- 

 tions. 



Treatment. The main object of treatment is the evacua- 

 tion of the contents of the stomach. Mild cases of primary dila- 

 tation of the stomach may be treated by laxatives, especially 

 aloes (25.0-35.0 gm.) alone or w^ith neutral salts (100-150 gm.) or 

 rheum (20-25.0 gm.), or salts alone in large doses (sulphate of 

 sodium, sulphate of magnesium) (200-300 gm.). These are best 

 given as pills or electuaries, anyhow with little water. Forssell 

 recommends for the affection i2 gm. of lactic acid (75%) in a 

 pint of water, using it with the apparatus of Goldbech ; in dan- 

 gerous cases a repetition of the dose may be indicated after 

 one-half to three-quarters of an hour. Forssell claims that the 

 administration of lactic acid imparts to the gastric contents that 

 degree of acidity which will favor its removal into the intestines. 

 The experience of the authors, however, teaches that grave cases 

 of gastric dilatation cannot be cured by this treatment and that 

 evacuation by the stomach tube becomes necessary in order to 

 avoid rupture of the stomach or suffocation. One may, on the 

 other hand, inject subcutaneously sulphate of eserine (0.08-0.10 

 gm.) or arecoline (0.06-0.08 gm.). These drugs have to be used 

 very cautiously, because they may cause sudden death by par- 

 alysis of the myocardium or strong contraction of vessels in an- 

 imals suffering from diseases of the heart or lungs, or they may 

 increase the contraction of the gastric muscularis, increase the 

 pains, cause more reckless rolling and so increase the danger 

 of rupture of the stomach if its contents are not expelled, in 

 spite of their administration. 



